Compliance Resources to Help you Stay Current

There's a lot of buzz around HCCs in the healthcare. But not everyone understands why and how to use them. Coding and auditing errors can have a negative impact on the organization’s revenue cycle. Hospital and clinical staff, including Directors, Auditors, CDI staff, Managers, CDI Clinicians and coding compliance and privacy staff should understand the key components of the HCC coding and auditing.

Grievances and Complaints - An overview of the CMS, Joint Commission, DNV and OCR Standards Hospitals should know about

No hospital wants to receive a statement of deficiencies and plan of correction from the regulatory bodies. Non-compliance with the grievance requirements is the third most problematic area that invites investigation. What if a CMS surveyor shows up at your hospital unannounced? Is your hospital compliant with the all the grievance requirements by CMS, OCR, and the complaint standards by the Joint Commission or your accreditation organization?

Effective management of patient complaints and grievances, can bolster systems and individual performance, and provide quality improvement opportunities.

Aimed at spurring medical innovation, expanding mental health treatment, speeding up access to new drugs, and combatting opioid abuse, the bill, termed 21st Century Cures Act, promises plenty.

Health is a priority. No doubts about that. Fact, that people on this planet are getting more and more urges the healthcare landscape to create and adapt on enhancing the quality of patient care keeping low costs. Nowadays, you are linked from hospital administrator to hospital systems, hospital networks and so on. It is like a spider net - when you get in - it is hard to get out.

DHS Issues Guidance on HIPAA and Cloud Computing

Cloud computing, an indelible part of healthcare systems and networks today, will now be regulated and brought under the HIPAA fold. DHS released the guidance that details the requirements for cloud computing service providers (CSP providers), clarifying that CSPs that create, receive, maintain, or transmit PHI (protected health information) on behalf of a business associate or covered entity are deemed business associates according to HIPAA.

No – Over-the-Counter or OTC drugs are not covered by the Centers for Medicine and Medicaid Services’ (CMS) newly proposed Physician Payment Sunshine rule.

According to the Act and proposed rule, the requirements apply to manufacturers of a “covered drug, device, biological, or medical supply."

A covered drug, device, biological or medical supply refers to any drug, biological product, device, or medical supply for which payment is "available" under Medicare, Medicaid, or CHIP.

Over-the-counter (OTC) drugs and biologicals are not covered by this rule.

Read an overview and summary of requirements of the proposed rule.

Yes – but only payments above $10 made to covered recipients (i.e., physicians or teaching hospitals) have to be reported by manufacturers under the proposed rule, part of the enforcement requirements included in the Physician Payment Sunshine Act of 2010. This rule has been drafted by the Centers for Medicine and Medicaid Services (CMS), which has been tasked by the government to enforce the Act’s requirements.

For failing to report, manufacturers will be subject to a civil monetary penalty of not less than $1,000, but not more than $10,000, for each payment or other transfer of value or ownership or investment interest not reported.

For knowingly failing to report, manufacturers will be subject to a civil monetary penalty of not less than $10,000, but not more than $100,000, for each payment or other transfer of value or ownership or investment interest not reported.

Read an overview and summary of requirements of the proposed rule.
 

The Physician Payment Sunshine Act was passed in 2010 as part of President Barack Obama’s legislative agenda to overhaul healthcare. The Centers for Medicine and Medicaid Services (CMS) was tasked with the drafting of the rules to enforce the Act’s requirements. CMS published its proposed rule in December, 2011.

This article gives a brief overview of the proposed rule and its requirements.
 

The Centers for Medicare & Medicaid Service (CMS) launched the Medicaid Integrity Program (MIP) to increase the resources available to CMS to combat fraud, waste and abuse in the Medicaid program. The Medicaid Integrity Program was established in section 1936 of the Social Security Act (the Act) (Public Law 109-171) by Section 6034 of the Deficit Reduction Act of 2005 (DRA).

The Small Business Health Fairness Act of 2005 is a bill to amend Title 1 of the Employee Retirement Income Security Act of 1974 (ERISA) to provide for the establishment of Association Healthcare Plans (AHPs), to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees.

The term managed care describes a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care for organizations that use those techniques or provide them as services to other organizations, or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts.

States have regulated managed care organizations to ensure their financial solvency, including their ability to cover the risk of enrollees. Nearly all have passed "patient protection" or consumer-oriented laws and/or regulations.

Privacy is personal to all individuals and in there is a constant need for its protection and efforts are directed to stop such information from being compromised. The Privacy Act was enacted in 1974 in the US and it seeks to put into place a Code of Fair Information Practice governing the collection, maintenance use and dissemination of personally identifiable information about individuals. This Act concerns itself with all information that is maintained in systems of records by the federal agencies. The Privacy Act prohibits the disclosure of information from a system of records without the written consent of the subject individuals, unless the disclosure is with respect to certain statutory exceptions to the rule. When an individual seeks to access or amend their records, they need to adhere to the guidelines as laid down in the Act.

Patients with metabolic syndrome need to be evaluated for compliance with drug treatment to determine association between access to and use of medicines, as well as the level of knowledge of cardiovascular risk factors and compliance. Metabolic syndrome includes a group of conditions that, when occurring together, place a person at a high risk of developing type 2 diabetes and cardiovascular diseases, including heart attack and stroke.

The Centers for Medicare & Medicaid Services regulate all laboratory-testing performed on humans in the US through the Clinical Laboratory Improvement Amendments (CLIA). CLIA covers approximately 200,000 laboratories. The Division of Laboratory Services, within the Survey and Certification Group of the Center for Medicaid and State Operations, implements the CLIA.

A new Canadian law came into effect after receiving the Royal Assent - the Canada Consumer Product Safety Act (CCPSA). The federal Minister of Health, Honorable Leona Aglukkaq stated, "I am delighted our Government's Consumer Product Safety Act is now the law of the land," said Minister Aglukkaq. "This will give the Harper Government important new tools to deliver stronger, more effective protection for Canadian consumers and their families."

The COBRA or Consolidated Omnibus Budget Reconciliation Act was passed in 1985 by the U.S. Congress. The Act’s most important regulations cover provisions for health benefits to workers and their families who lose their jobs. This part of the Act has gone through several changes in recent years since the recession hit, specifically its provisions for subsidy eligibilities. This article describes the background, key provisions and recent changes to this important Act.

In an alarming revelation, statistics have proved that one out of every seven Medicare patients hospitalized suffers from some kind of physical or mental harm during the stay at the hospital, and adverse circumstances at the hospitals contribute to 180,000 deaths every year, according to a recent study undertaken by the government.

Rite Aid Corporation, charged with failing to protect its customers’ and employees’ sensitive and financial privacy, received a final order approved by the Federal Trade Commission (FTC) to settle charges. Members of the public who put forward commends on the order received letters from the FTC. In line with the order, Rite Aid is obligated to ensure several measures. This includes setting up a comprehensive information security program that will protect the integrity, confidentiality, and security of the personal information collected from employees and customers.

The Patient Protection and Affordable Care Act (PPACA), a federal statute signed into law in the United States by President Barack Obama on March 23, 2010 along with the Health Care and Education Reconciliation Act of 2010, is an outcome of the health care reform agenda of the Obama administration.

The intention behind the 8-month-old health care law passed by the Congress was to push doctors and hospitals to jointly take the responsibility for bringing down the cost and improving the quality of patient care and possibly reward them with bonuses for achieving it.